《临床抗菌药物使用干预相关研究的现状.pptVIP

Impact of an antibiotic restriction policy on the antibiotic resistance patterns of Gram-negative microorganisms in an Intensive Care Unit in Greece International Journal of Antimicrobial Agents 30 (2007) 360–365 Hospital: An university affiliated tertiary-care state institution with 700 beds.The ICU is a 12-bed multivalent unit. Aim: 检验限制头孢他啶和奎诺酮类药物的经验用药可以降低铜绿假单胞菌、鲍氏不动杆菌和肺炎克雷伯菌耐药率的假设。 Periods: 干预前期： 20031.1-2003.6.30 干预期： 2003.7.1-2005.6.30 干预后期：2005.1.1-2005.6.30 5. Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. 数据：: 患者年龄、性别、住ICU天数、病原菌种类、耐药情况等 入院时采集呼吸道和消化道标本，进行细菌培养，入院一周后重复一次。 在经验用药或调整药物种类后立即进行定植G-菌药敏试验. 抗菌药物使用: DDDs per 100 ICU patients-days (version ATC 2006). 研究期间医院感染控制措施保持稳定 采用头孢吡肟, 氨基糖苷类作为限制药物的替代药物.在严重脓毒症或脓毒性休克时选用哌拉西林/他唑巴坦\碳青酶烯类和多粘菌素进行治疗. 药物选择依据可抑制ICU优势的产ESBL的铜绿假单胞菌为原则. Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. Antibiotic consumption 除多粘菌素,头孢吡肟和庆大霉素外,其他药物的消耗量均大幅度下降. 环丙沙星和奎诺酮类的消耗大幅度下降 (85.2% and 92.1%, respectively; P 0.05). 头孢他啶下降了96.4%,三代头孢菌素消耗量下降了 81.6%. 头孢吡肟用量上升了270%, 碳青酶烯类下降了22.7%.多粘菌素消耗量明显增加 (from 0 DDD/100 bed-days to 20.8 DDD/100 bed-days; P0.05). 氨基糖苷类明显下降 (58.4%; P 0.05),.哌拉西林/他唑巴坦下降了38.1% (P0.05). 抗菌药物 总体下降55.4% (P 0.05). Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. 研究期间肠道病原菌定植情况: 肺炎克雷伯菌92%,铜绿假单胞菌37%, 鲍氏不动杆菌(18%). 几乎半数的患者在入住ICU 时肠道已有多重耐药的病原菌定植. Evaluation only. Created with Aspose.Slides for .NET 3.5 Client Profile 5.2.0.0. Copyright 2004-2011 Aspose Pty Ltd. 结论: 限制抗菌药物使用的措施可以导致病原菌耐药水平的下降,尽管有时很慢.但有些变化并不是我们所希望的,这表明耐药病原菌很难根除. 抗菌药物的限制措施必须有相应的卫生措施配合,以防止耐药病原菌在病区环境内扩散,